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NPI Code Detail

MEDICARE: MRS. CANDACE MAYBERRY FARMER MSW, LCSW

MEDICARE: MRS. CANDACE MAYBERRY FARMER MSW, LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerP002719NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1C006688OTHERNCLCSW
2P002719OTHERNCSOCIAL WORK CERTIFICATION AND LICENSURE

General Provider Information

NPI Number : 1306085519
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CANDACE MAYBERRY FARMER MSW, LCSW
Provider Business Mailing Address
First Line : 13420 REESE BLVD W
Second Line :
City : HUNTERSVILLE
State : NC
Zip : 28078-7925
Country : US
Telephone Number : 704-433-6644
Fax Number : 980-207-2796
Provider Business Practice Location Address
First Line : 13420 REESE BLVD W
Second Line :
City : HUNTERSVILLE
State : NC
Zip : 28078-7925
Country : US
Telephone Number : 704-433-6644
Fax Number : 980-207-2796
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2009
Last Update Date : 03/20/2017

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